Why Will A Social Security Disability Application Get Denied?

There are basically two types of disability application denials: technical and medical. If a disability application is denied for technical reasons, the application will never be sent for a medical determination. Technical denials include lack of insured status denials, performance of SGA denials, and res judicata denials.


The first type

1. Lack of insured status denial- A disability denial that is based upon an individual not having earned enough quarters of coverage to be insured for disability benefits. Quarters of coverage can be earned at a rate of four per year provided an individual has earned enough money for that year. An individual’s age at the time of they became disabled determines how many quarters of coverage are needed to be eligible for Social Security disability.

2. Performance of SGA denial- Each year Social Security determines a gross monthly earnings amount that it considers to equate with substantial gainful work activity. If an individual is earning over this amount, their disability claim will be denied.

3. Res judicata denial- A disability denial that is based upon a decision made in the past that was after the date an individual was last insured for Social Security disability. If the person has no new work activity, Social Security deems the Social Security disability issue closed.

4. Failure to cooperate denial- This is a denial that is based upon an individual’s failure to provide information or paperwork that is necessary to process their disability claim (whether or not a failure to cooperate denial is technical or medical will depend on where it occurs, i.e. at the social security field office or at the disability determination services agency).

The second type

The second type of denial is a medical denial. Medical denial decisions are made by disability examiners at the state disability agency and are based upon an individual’s medical impairment, residual functional capacity, work history, age, and education. Disability examiners can also deny a claim for failure to cooperate if an individual does not provide them with information or fails to attend a consultative examination, and these denials are considered medical denials.




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Social Security Disability Benefit Questions



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Applying for Social Security Disability and Schizophrenia

Here's an excerpt from the page on this site that deals with the schizophrenia listing in the social security disability list of impairments, otherwise known as the blue book. This is the manual used by both disability examiners and administrative law judges to determine if claimants are eligible for disability based on equaling or meeting the criteria established for a specific physical or mental impairment.

Schizophrenia is a medical condition listed in the official Social Security official list of impairments, or the blue book, as it is more commonly called. Schizophrenia falls under heading 12.03, Schizophrenic, Paranoid, and Other Psychotic Disorders, and the criteria that must be proven to meet this listing are complex, to say the least. In fact, the description of schizophrenia listed in the blue book is complicated enough to make this condition a perfect example of why so many who file for Social Security Disability (SSD) or SSI can benefit from legal representation at the hearing level where a federal judge presides.

The rest of the page can be viewed at this link: Social Security Disability and Schizophrenia

Here are some other pages from the site that may be relevant and useful.

1. Mental Illness and Social Security Disability

Excerpt: "Disability examiners are not licensed psychiatrists, and do not always understand the full scope of the limitations imposed by certain mental illnesses. For instance, some disability examiners do not recognize the cyclical nature of mental illnesses"

2. How Do You Pass a Social Security Mental Exam?

Excerpt: "Consultative mental examinations (CE appointments) are often used if an individual has no current mental health treatment notes or no record of mental health treatment at all. As you might imagine, these types of examinations are typically a poor substitute for a documented history from a mental health professional"

3. Not alleging mental conditions on a social security disability application

"Why do some claimants fail to disclose all their conditions when they file an initial claim for benefits. The reasons probably vary. In some cases, a claimant may believe that, though they are treated for a mood disorder, or other psychiatric impairment, the severity of the condition may not warrant an approval for disability benefits"





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Social Security Disability Secrets

Social Security Disability Benefit Questions

Applying for Disability Through SSI, it is Evaluated The Same as SSD

Social Security administers two disability programs: Social Security Disability (SSD) and Supplemental Security Income disability (SSI). Social Security disability is based upon an individual’s insured status (insured status is earned through work); conversely Supplemental Security Income disability is strictly a need-based program. Naturally, each disability program has its own non-disability rules and guidelines that must be met.

That being said, Social Security uses the same disability medical decision-making process for both programs. In fact, many disability applicants file for SSD and SSI simultaneously and one medical determination is made for both programs.

So just how does the Social Security disability evaluation process work? All Social Security disability applicants must file a disability claim, and this can be done via the internet, phone or an in-office disability appointment at your local Social Security office.

If an applicant chooses to file their disability claim via the internet, they will only be able to file for Social Security disability. Consequently, if an applicant wishes to file for SSI in addition to SSD, they should file their disability claim via a phone interview or in office interview.

Additionally and very importantly (since many applicants miss this), if an applicant files an internet disability claim, they should complete the disability medical forms as well.

A word of caution, a completed medical disability form does not give a protected filing date, so it is important to complete the online disability application as well. For the time being, Social Security in-office interviews and telephone interviews are the most comprehensive methods of completing the needed disability information.

Not matter which method of interview an applicant chooses, the completed disability claim is set to a state agency responsible for making Social Security medical determinations for a decision. Disability examiners develop disability claims through acquiring medical records, questionnaires (from you and a third party), and consultative medical and/or mental examinations.

Once the disability examiner has all the necessary development complete, they will make a disability decision for both SSD and SSI. If an applicant receives a denial for disability benefits, they can appeal the denial. Once again, Social Security uses the same disability process for both SSI and SSD.

In conclusion, Social Security uses the same application and medical disability determination process for both SSD and SSI.






Return to:

Social Security Disability Secrets

Social Security Disability Benefit Questions


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What Are The Steps to Applying for Disability?

In order to apply for benefits from a disability program administered by the Social Security Administration, you must meet certain disability criteria.

For instance, you must have a medically determinable medical and/or mental condition that is verified by objective medical findings (i.e. various medical tests, psychological testing, or psychiatric evaluations). Additionally, you must have been unable to perform substantial work activity for twelve months (or expect to be unable to perform work activity for twelve months) as a result of your disabling impairment, or impairments, or your condition must be expected to result in death.

If you meet the general disability criteria for one of the two SSA disability programs (those programs being social security disability and SSI disability), what are the steps to actually applying for disability?

Generally, the first step to the disability process is to contact Social Security for a disability interview, either by phone or in person at your local Social Security office.

Recently, Social Security has begun to allow individuals to file their Social Security disability claim online. Although this is convenient, you should consider the fact that you cannot file for SSI online at this time (many individuals will not know beforehand if their application for disability will be for SSI, SSD, or will be concurrent meaning than an application will be taken in both programs). You also must fill out all the necessary disability forms and return your medical release forms to Social Security even if you file your claim online.

Basically, it is your choice as to how you complete your disability interview. However, you may wish to consider the fact that you will probably have questions about filing and about the process of being evaluated that you would like to receive immediate answers to. If that's the case, you may wish to opt for an in-person interview and application---which may be obtained by simply contacting a local social security office and scheduling an appointment.

Once you have completed the initial disability interview, your claim will be sent to a state disability agency for processing. During this time, you may be required to provide other information in order for the disability examiner to make a medical determination.

When applying for Social Security disability, it is important to provide all the necessary information timely and completely. This may mean that you may have to fill out additional forms (and return them) or attend a consultative examination. And, if you fail to do so, your disability claim may be denied.

The disability application process does not end with the initial disability interview; rather it is an ongoing process that only ends when you have won your disability benefits. This may mean that you have to appeal your initial disability decision, if you are denied.

The Social Security disability appeal process, of course, can be a lengthy one that requires you to file paperwork timely and perhaps even attend an administrative law judge hearing. Currently, nearly three-quarters of all disability applications are, in fact, denied. And most claimants who eventually win their disability benefits only receive them after having appealed their claim to the level of a disability hearing before an administrative law judge.





Return to:

Social Security Disability Secrets

Social Security Disability Benefit Questions


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How to file a request for a social security disability hearing?